Braces Versus Invisalign®: Gingival Parameters and Patients' Satisfaction During Treatment: A Cross-sectional Study

A. Azaripour; J. Weusmann; B. Mahmoodi; D. Peppas; A. Gerhold-Ay; C. J. F. Van Noorden; B. Willershausen


BMC Oral Health. 2015;15(69) 

In This Article


Patient Characteristics

A total of 100 orthodontic patients met the inclusion criteria and were enrolled. The age of the patients varied from 11 to 62 years. Fifty patients received treatment with Invisalign® (11 male and 39 female) and 50 with FOA (16 male and 34 female). The patients in the FOA group (n = 50) were on average 16.3 ± 6.9 years old with an age range of 11–61 years. The Invisalign® patients (n = 50) were on average 31.9 ± 13.6 years of age with a range of 12–61 years. The majority of the participants was female (FOA: 68 %, Invisalign®: 78 %). Orthodontic treatment was performed for 12.9 ± 7.2 months in FOA patients and 12.6 ± 7.4 months in Invisalign® patients at the time of the screening visit (Table 1).

Clinical Outcomes

Prior to Orthodontic Treatment (Baseline Visit). The analysis of the data showed no differences in periodontal conditions prior to the orthodontic treatment. Both groups had implemented good oral hygiene as measured by API: 19.6 % ± 7.0 (FOA patients) and 16.3 % ± 9.6 (Invisalign® patients) and had good periodontal health (Table 2).

Screening Visit During Orthodontic Treatment. There were notable changes in periodontal conditions in both groups during orthodontic treatment. Dental plaque measured by API or MPI had increased in both groups but was higher in the FOA patients (37.7 % ± 21.9) as compared to the Invisalign® patients (27.8 % ± 24.6). These differences were not significant. Invisalign® patients showed significantly better gingival conditions than FOA patients. GI and SBI values were hardly increased in Invisalign® patients during orthodontic treatment whereas GI and SBI values increased 2-fold in FOA patients during orthodontic treatment (Table 2).

Subjective Data Obtained With Quality-of-life Questionnaire

The quality-of-life questionnaire revealed that Invisalign® patients reported less impairment on general well being as compared to FOA patients (6 % versus 36 %, p = 0.001). More FOA patients than Invisalign® patients reported to suffer from laughing inhibition because of esthetics (26 % versus 6 %, p = 0.012), whereas 98 % of the Invisalign® patients would be willing to undergo the same treatment again, and 78 % of the FOA patients (p = 0.004). Furthermore, 70 % of FOA patients compared to only 50 % of Invisalign® patients reported that their eating habits had changed during orthodontic treatment (p = 0.066). FOA-treated patients reported more frequently to have to brush their teeth more often than before the start of the orthodontic treatment (84 % FOA patients versus 52 % Invisalign® patients, p = 0.001), whereas approx. 50 % of the patients in both groups used an electric toothbrush (Table 3). The FOA patients reported more gingiva irritation in comparison to the Invisalign® patients (FOA: 56 %; Invisalign®: 14 %; p = 0.001).

Table 3 shows that FOA patients spent 3.7 ± 1.7 min on average as tooth-brushing time with a minimum of one min and a maximum of 15 min, whereas Invisalign® patients reported to brush their teeth on average during 2.2 ± 1.2 min with a minimum of 1.5 min and a maximum of up to 8 min. FOA patients did not change their toothbrush as frequently as Invisalign® patients.